| NPI | 1093489718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 91153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL17346) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2024-06-25 |